tb

Revised National Tuberculosis Control Programme
Revised Schemes for NGOs
and Private Providers
Central TB Division, Directorate General of Health Services
Ministry of Health and Family Welfare, Nirman Bhavan, New Delhi 110108
http://www.tbcindia.org
August 2008

i
Introduction
RNTCP recognizes the need for involvement of all sectors –public and private
to create an epidemiological impact of Tuberculosis control .The private
health sector in the country is an important source of care even with the
availability of public health services. The NGOs and private providers are
often closer to and more trusted by patients and perform an active role in
health promotion in the community.
Public private mix (PPM) has been recognized as an important component in
the RNTCP. The aim of public private mix-DOTS (PPM-DOTS) is to
effectively link the national TB programme and all public and private health
care providers presently out of realms of national TB programme efforts so as
to provide standardized treatment to all TB patients in the country.
The Government of India developed guidelines for NGO and private sector
involvement in TB control which were published in 2000 and 2001
respectively. Today, PPM in RNTCP has come a long way with a support of
over 2500 NGOs, 25000 PPs, 260 Medical colleges and 150 corporate
houses which are providing DOT services.
Over a period of 7-8 years it has been observed that the uptake of schemes
under a formal agreement has declined. There was a felt need for revision of
the current schemes in view of the newer initiatives like DOTS plus, TB- HIV
collaboration to improve the access of DOTS for the TB patients. The
emergence of Multi-drug resistant TB has posed a challenge to the RNTCP
implementation. The long duration of treatment would require social support
network to facilitate adherence to ambulatory treatment. The DOT services in
urban slums require involvement of private and NGO sectors to reach to
special groups like migrants and slum dwellers.
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Therefore, the GoI approved NGO/PP schemes of 2000-01 required updation
to meet the challenges of the present day programme implementation .
The Central TB Division conducted a three day Consultation on Revision of
NGO/PP Guidelines in January 2008 in Delhi to improve the collaboration
with private sector in all aspects of RNTCP implementation with the following
objectives-
􀂾 To review the progress in involvement of NGO/PP in RNTCP since the
formulation of schemes and share experiences ,
􀂾 To review the present NGO/PP schemes , identify constraints and
suggest improvements,
􀂾 To recommend new schemes to improve the collaboration with other
sectors in all aspects of RNTCP implementation.
The Consultation was held with 60-70 participants which included programme
managers like STOs, DTOs, of regions where NGOs/PPs have been active in
RNTCP; professional bodies like IMA and NGO representatives both from
within the programme and outside RNTCP.
The Consultation was held to have a consensus on the revised schemes in
consultation with the stakeholders by sharing experiences from currently
involved NGOs/PPs; NGOs/PPs who have discontinued their services under
RNTCP due to operational problems with the existing schemes; NGOs/PPs
who have not come forward due to non-flexibility in the present schemes.
New schemes were also discussed to include private providers to facilitate
the Culture and DST in private labs, sputum collection centres and TB HIV
collaboration
The present guidelines are a result of deliberations in the various STOConsultants’
meetings ,State Reviews, experiences from the fields and
repeated discussions in the Central TB Division and Integrated Finance
Division after the National Consultation held in Delhi.
August 2008
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Table of Contents
ACSM Scheme: TB advocacy, communication, and social mobilization 1
Introduction ........................................................................................................................... 1
Eligibility ................................................................................................................................ 1
Role of NGO ......................................................................................................................... 3
Role of RNTCP (DTO/STO) .................................................................................................. 3
SC Scheme: Sputum Collection Centre/s ................................................... 5
Introduction ........................................................................................................................... 5
Eligibility ................................................................................................................................ 5
Role of NGO/Collaborating partner ....................................................................................... 6
Role of RNTCP (DTO/STO) .................................................................................................. 6
Transport Scheme: Sputum Pick-Up and Transport Service ................... 9
Introduction ........................................................................................................................... 9
Eligibility ................................................................................................................................ 9
Role of NGO/Collaborating partner ..................................................................................... 10
Role of RNTCP (DTO/STO) ................................................................................................ 10
DMC Scheme: Designated Microscopy Cum Treatment Centre (A & B) 11
A. Designated Microscopy and Treatment Centre for a NGO/Private lab ........................... 11
B.Designated Microscopy Centre - Microscopy only ........................................................... 13
LT Scheme: Strengthening RNTCP diagnostic services ........................ 17
Introduction ......................................................................................................................... 17
Eligibility .............................................................................................................................. 18
Role of NGO/Collaborating partner ..................................................................................... 18
Role of RNTCP (DTO/STO) ................................................................................................ 19
Culture and DST Scheme: Providing Quality Assured Culture and Drug
Susceptibility Testing Services ................................................................. 21
Introduction ......................................................................................................................... 21
Eligibility .............................................................................................................................. 21
Grant-in -aid ........................................................................................................................ 22
Responsibilities of the NGO/Private Facility: ....................................................................... 22
Responsibility of the respective STO: ................................................................................. 23
Adherence scheme: Promoting treatment adherence ............................ 25
Introduction: ........................................................................................................................ 25
Eligibility .............................................................................................................................. 25
Role of the NGO ................................................................................................................. 26
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Role of the Private Providers .............................................................................................. 27
Role of the District Health Society ....................................................................................... 28
Grant-in-aid (NGOs) ............................................................................................................ 29
Grant-in-aid (PPs) ............................................................................................................... 29
Slum Scheme: Improving TB control in Urban Slums ............................ 31
Introduction ......................................................................................................................... 31
Eligibility .............................................................................................................................. 31
Role of NGO/Collaborating partner ..................................................................................... 32
Role of RNTCP (DTO/STO) ................................................................................................ 33
Tuberculosis Unit Model ............................................................................ 35
General Description ............................................................................................................ 35
Role of the NGO ................................................................................................................. 35
Role of the District Health Society ....................................................................................... 36
Requirements/Eligibility Criteria .......................................................................................... 38
TB-HIV Scheme: Delivering TB-HIV interventions to high HIV Risk
groups (HRGs) ............................................................................................ 39
Background ......................................................................................................................... 39
Role of NGO/Collaborating partner ..................................................................................... 41
Role of RNTCP (DTO/STO) ................................................................................................ 42
PROCEDURES ............................................................................................. 43
I. Approvals ......................................................................................................................... 43
II. Period of Assistance ....................................................................................................... 44
III. Human resource ............................................................................................................ 44
Memorandum of Understanding (MoU) for the participation of Non-
Governmental Organisations (NGOs)/Private Providers ........................ 45
ACSM Scheme: TB advocacy, communication, and social mobilization
1
ACSM Scheme: TB advocacy, communication,
and social mobilization
Introduction
There is an unmet need for improved advocacy, communication,
and social mobilization (ACSM) to support ongoing TB control efforts in
all districts. Improved ACSM is expected to achieve the following
outcomes:
􀁠 Mobilization of local political commitment and resources for TB
􀁠 Improved case detection and treatment adherence.
􀁠 Empower people and communities affected by TB.
􀁠 Reduced stigma and discrimination against persons and
families affected by TB.
The NGO will be expected to coordinate with District RNTCP
units to implement a minimum set of advocacy, communication, and
social mobilization interventions in a district, either by themselves or
with partners. Implementing partners can include (PRI), Self-Help
Groups (SHG), faith-based organizations, Community-based
organizations, Rotary Club chapters, other NGOs, Panchayat
institutions, etc. The activities should reach an area with a minimum of
5,00,000 (0.5million) population, but preferably should cover 10,00,000
(1million) population or greater.
Eligibility
Any registered NGO with capacity and commitment with at least
2-3 years experience in social mobilization activities and grass root
level activities. Local presence and familiarity with local culture will be
desirable.
ACSM Scheme: TB advocacy, communication, and social mobilization
2
Grant-in-aid: Rs 1,50,000 per 1 million population per year, prorata
for population covered
The Grant-in-aid will include cost of activities and transportation/
mobility cost for the staff of NGO to undertake these activities through
out the district. The NGO will be expected to undertake certain
minimum number of activities every month within the assigned /agreed
upon geographical area/population within the district.
(For example certain number of community meetings, minimum
number of school activities, street plays, PRI sensitization meetings,
peer support group meetings along with DOT Provider have to be
organized by the NGO in the assigned area. Reproduction of
communication material or local adaptation of material will also be
responsibility of the NGO for effective implementation of
communication and social mobilization activities. Exact number of
proposed activities should be reflected in the annual work plan which
needs to be developed by the NGO and submitted to the district at the
time of signing of MoU)
There will be flexibility about the activities depending upon the
assessment of the situation by the NGO and deliverable (activities
proposed in the annual work plan with the time line) identified by the
NGO for the district in consultation with the district health society.
However, an approximate cost has been worked out on the basis of an
expected minimum number of annual activities in each district for a
population of one million. Kindly refer to the note below.
A total Grant-in-aid of Rs. 1, 50,000 per 1 million population per
year will be provided. If a larger population is covered with a larger
series of ACSM activities, then RNTCP support for the scheme would
be scaled up on a pro-rata basis.
(For example, if an area with 0.5 million population per year were
covered with a similar series of activities, then Rs 75,000 per year
would be provided. If an area with 1.5 million population per year were
ACSM Scheme: TB advocacy, communication, and social mobilization
3
reached with a larger series of activities, than Rs 2,25,000 would be
provided).
Role of NGO
The role of the NGO will be to plan and undertake a series of
ACSM activities in consultation with the District Health Society. The
proposed activities should complement and support the ACSM
activities planned by the District Health Society. The activities planned
should be based on the need assessment, programme performance,
and should be linked to work plan submitted at the time of signing the
MOU. The NGO is also expected to reproduce good quality
communication materials, ideally using prototype materials obtained
from the District / RNTCP website, which can be adapted for the local
language and context if necessary. ACSM activities can draw guidance
and inspiration from the publication- “Communication Strategy for
RNTCP” available at www.tbcindia.org or any publication that is
brought out by RNTCP from time to time.
Role of RNTCP (DTO/STO)
The role of the DTO/STO will include joint planning with the
NGO for identification issues that needs to be addressed to strengthen
ACSM component. DHS will help the NGO in identification of pockets
within the district which needs attention for awareness generation,
social mobilization and community empowerment. DHS will also share
ACSM District plan with the NGO in order to avoid duplication of
efforts. DHS will make available prototype material developed by the
district/ state/ centre.
Note:
(The following estimates may be referred for developing work plan.
The following is just a illustration, and doesn’t have to replicated as it
is. The NGO may include some/ all of the following activities in the
ACSM Scheme: TB advocacy, communication, and social mobilization
4
work plan. NGO is expected to have their own work plan depending
upon the assessment of situation and identification of communication
needs relevant to their assigned population)
Illustration:
Community meeting of at least 50 people @ Rs. 300 x 4 meetings x12
months = Rs. 14,400
School Activities Rs.1000 per activities X 12 months= 12,000
Sensitization meetings for PRIs/ SHGs/ religious heads @ Rs.500 per
meeting x12 months =Rs.6000
Patient provider meetings at the health facility along with the TB
support group at least two in a month @Rs.200per meeting x4
meetings per month x12months =Rs. 9,600
Reproduction of information material / local adaptation of material to be
used=Rs.33,000 / annum
Other innovative activities = Rs.25,000 / annum ( these needs to be
clearly indicated& fully justified in the work plan along with detail)
Travel and mobility cost= Rs. 50,000 / annum (these should be
elaborated in the work plan).
SC Scheme: Sputum Collection Centre/s
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SC Scheme: Sputum Collection Centre/s
Introduction
Quality assured sputum smear microscopy is the backbone of
tuberculosis diagnosis. However, persons suspected of having TB are
required to submit sputum specimens two to four times during
diagnosis; if diagnosed with TB, again sputum specimens are required
several times throughout treatment to monitor progress. To enhance
equity and accessibility of TB health care delivery services, sputum
collection should be as close and convenient to patients as possible.
RNTCP has established over 12,000 Designated Microscopy
Centres (DMCs) in the entire country, but there are still areas where
accessibility to DMCs is sub-optimal. The expansion of the DMC
network is limited due to the strict requirement for quality assurance of
services and for maintaining proficiency of laboratory technicians.
Hence in these areas with sub-optimal access to DMCs, it is envisaged
that NGO/private provider supported sputum collection centres can be
established to provide ease of accessibility to patients. Sputum
specimens collected will be subsequently transported to the nearest
DMC, enhancing the coverage of RNTCP and improving convenience
to patients.
Eligibility
Any institution in “underserved” areas with convenient access at
appropriate times to the population served. Underserved areas are
defined as those settings with justifiably difficult access to microscopy
services. This may be difficulty based on distance, poor public
transport network connectivity, population characteristics that
complicate access to existing DMCs (e.g. a slum in an urban area, or
tribal village). The institution should have a conducive area for sputum
SC Scheme: Sputum Collection Centre/s
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collection, including well ventilated open spaces for sputum
expectoration. The manpower to conduct the related activities as per
RNTCP guidelines should be present.
Role of NGO/Collaborating partner
􀁠 Sputum collection from TB suspects referred from outpatients
of the same facility, the surrounding community, and other
facilities linked in the vicinity
􀁠 Collect diagnostic and follow up sputum specimens following
RNTCP guidelines.
􀁠 Ensure adherence to guidelines on sputum collection in order
to obtain good quality sputum samples.
􀁠 Ensure accurate recording in lab forms and dispatch lists,
labelling, recording and packaging of samples,.
􀁠 Ensure that a mechanism for transportation is in place (via
Transport Scheme or via general health system), and that
there is timely communication of sputum results back to
referring providers.
􀁠 Standardized kits for transportation to be procured by the
NGOs
Role of RNTCP (DTO/STO)
􀁠 Identification of underserved areas for Sputum Collection
Centre, and planning in collaboration with prospective partner
implementing scheme and nearby DMC.
􀁠 Arrange for sputum microscopy at DMC and timely
transmission of results for treatment initiation and follow up
SC Scheme: Sputum Collection Centre/s
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􀁠 Training of the concerned staff and provision of materials,
including sputum cups.
􀁠 To ensure the mechanism for transport of sputum is in place
prior to initiation of operations of a sputum collection centre.
Grant-in-aid: Rs 60,000 per annum, per centre
Based on estimate of Rs 3000 facility cost reimbursement and
Rs 2000 service cost reimbursement (monthly), a total reimbursement
of Rs 60,000/- per annum per sputum collection centre, lump sum has
been established.
Rs 350 per sputum collection box to be reimbursed by District
Health Society (DHS). No. of boxes provided by DHS can be worked
out according to the workload, and should be included in the MOU.
Specifications for the new sputum “transporting box” for Safe,
Convenient collection, Storage & Transportation of Sputum.
Specifications- Box of ‘6’ Sputum Containers (2 Boxes) - 12 Pcs.
Containers - Covered with Pocket & Double Handle Belt.
Box of Sputum Container- Made of Special Medical Grade polypropylene,
Autoclavable, Translucent and Capacity – at least 6
Sputum Containers.
Plastic Sputum Container- Made of Special Medical Grade polypropylene,
Lock type Screw Cap-Air tight - Thin Plastic Translucent,
Autoclavable Diameter- 4 cm, Capacity- 30 ml
Also Cap is made of Special Medical Grade Polypropylene
Cover- Made of Quality Water Resistant Washable Cloth,
Double Handle Belt, One Outer Pocket for Keeping the
document.
SC Scheme: Sputum Collection Centre/s
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Transport Scheme: Sputum Pick-Up and Transport Service
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Transport Scheme: Sputum Pick-Up and
Transport Service
Introduction
Quality assured sputum smear microscopy is the backbone of
tuberculosis diagnosis. However, persons suspected of having TB are
required to submit sputum specimens two to four times during
diagnosis; if diagnosed with TB, again sputum specimens are required
several times throughout treatment to monitor progress. To enhance
equity and accessibility of TB health care delivery services, sputum
collection should be as close and convenient to patients as possible.
Sputum Collection Schemes may help bridge this gap, but
transportation of specimens is still required, which might be done by
the same organization running Sputum Collection Schemes, or a
different organization altogether.
Keeping in view the need for safe and timely transportation of
sputum while maintaining the acceptable quality of collected sample for
microscopy examination, the programme envisages a Sputum
specimen Pick-up and Transport Service of these samples by non
governmental organizations or private agencies having their presence
in the identified areas. Provision of such services would enable the
programme to access the underserved populations of the country,
enhancing the coverage of RNTCP and improving convenience to
patients.
Eligibility
NGO / Community Based Organisation (CBO) with outreach
workers, or private organization with the capacity to transport sputum
specimens as per RNTCP guidelines.
Transport Scheme: Sputum Pick-Up and Transport Service
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Role of NGO/Collaborating partner
􀁠 Coordinate with the assigned Sputum Collection Centres and
the DMCs.
􀁠 Transport samples safely to DMCs periodically.
􀁠 Convey the results in dispatch lists and forms to the Sputum
Collection Centres.
􀁠 Maintain travel log book.
Role of RNTCP (DTO/STO)
􀁠 Planning and allocation of Sputum Collection Scheme and
transportation in collaboration with DMC MO and external
partners
􀁠 Training of the concerned staff and provision of materials
listed
􀁠 Ensuring quality microscopy and timely transmission of results
Grant-in-aid: Rs 24,000 per annum (for a maximum of 20 visits per
month)
DMC Scheme: Designated Microscopy Cum Treatment Centre (A & B)
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DMC Scheme: Designated Microscopy Cum
Treatment Centre (A & B)
A. Designated Microscopy and Treatment Centre for a
NGO/Private lab
General Description
The NGO/private lab serves as a microscopy and treatment
centre and is designated as such by the RNTCP.
Role of the NGO
The NGO/private facility provides AFB microscopy and TB
treatment services free of charge. Technical policy for collection and
examination of sputum and for providing anti-TB treatment is strictly as
per RNTCP policy. Record-keeping and quality control are also to be
done as per RNTCP policy. The NGO/private facility is responsible for
ensuring the treatment or referral of all patients found to have a
positive AFB smear, and for ensuring follow-up treatment and sputum
examinations for all patients placed on treatment. The NGO/private
facility must ensure referral for treatment of patients found to be
smear-positive but who live outside the NGO/private facility catchment
area. All sputum smear-negative cases should be given two weeks of
antibiotics,free of cost, before they are sent for X-ray examination, as
laid down in the diagnostic algorithm.In the case of patients with chest
symptoms who are found to have negative AFB smears or are
suspected to have other forms of tuberculosis, the NGO/private facility
will either evaluate the patient as per RNTCP policy, or will refer the
patient to an identified referral centre for such evaluation.The
NGO/private facility must ensure that, in addition to a trained laboratory
technician,there is a qualified Medical Officer (MO) trained in the
RNTCP.
DMC Scheme:Designated Microscopy Cum Treatment Centre (A & B)
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Role of the District Health Society/District TB Centre
The TB Programme will provide training and technical guidance
and will perform laboratory quality control. In addition, the programme
will assist the NGO/private facility in ensuring evaluation of smearpositive
patients who live outside the catchment area of the
NGO/private facility and have been referred by the NGO for treatment.
The TB Programme will monitor diagnostic quality (three smears taken
for diagnosis and two for follow-up, proportion of positive smears,
proportion of smear-negative cases, if any). The TB Programme will list
the facility as an approved RNTCP microscopy centre, as long as
performance is satisfactory and RNTCP policies are adhered to.
Commodity Assistance
In kind
The RNTCP will provide commodity assistance of laboratory
materials and reagents (including sputum containers, equipment for
waste disposal, and civil works) as needed, as well as laboratory forms
and TB Laboratory Register. Anti-TB drugs will also be provided for
patients, started on RNTCP treatment, who live in the catchment area
of the NGO/private facility. If needed, the TB Programme may provide
a microscope.
Grant-in-Aid
Annual grant-in-aid of Rs 1,50,000 .
*If the DMC wishes to start a Treatment centre then it may be allowed
but only Honorarium will be paid .No further administrative costs will be
given.
Requirements/Eligibility Criteria
􀁠 The NGO must be registered under the Societies Registration
Act, and should have a minimum of 3 years experience in the
area of operation
DMC Scheme: Designated Microscopy Cum Treatment Centre (A & B)
13
􀁠 Availability of necessary infrastructure including a room of at
least 10' x 10' size with laboratory facilities (water, sink, etc.).
􀁠 Necessary equipment including a Binocular Microscope to
undertake smear microscopy
􀁠 Necessary staff including at least one Medical officer and one
Laboratory technician and/ or volunteers required in the field.
􀁠 All anti-TB medications and other services under the RNTCP
will be provided free of cost.
􀁠 The Microscope and unused materials and reagents will have
to be returned to DHS in the event that the NGO ceases to
function as a microscopy centre.
B.Designated Microscopy Centre - Microscopy only
General Description
A private health facility having its own laboratory serves as an
approved microscopy centre and is designated as such by the RNTCP.
Patients are not charged for AFB microscopy, and the materials for
microscopy are provided to the microscopy centre.
In general, this should be considered for heavily utilized
laboratories already having a large volume of patients being examined
for diagnosis. It may also be considered for areas where the
governmental infrastructure is not sufficient to ensure effective RNTCP
implementation and where an effective private organization is currently
working in the health field in this area.
Private Practitioner Role
The health facility must strictly adhere to RNTCP policies on
sputum microscopy as outlined in the Manual for Laboratory
Technicians and the Laboratory Technicians Module, including proper
maintenance of a TB Laboratory Register. LT should also preserve
DMC Scheme:Designated Microscopy Cum Treatment Centre (A & B)
14
slides for cross checking by STLS as per quality assurance protocol of
RNTCP. All diagnosed TB patients must be informed of the availability
of free services and referred to Government MCs or DOT centres for
categorization and treatment.
It is the laboratory’s responsibility to ensure that the results of
microscopy are conveyed to the referring institution/worker/doctor,
generally within one day. This should be strictly ensured for patients
found to have one or more positive AFB smears. In case its services
are disrupted for any reason, he laboratory should inform all referring
physicians and the DHS in advance. The laboratory will prepare a
monthly report which will be collected by STLS during his visits to the
microscopy centre.
Role of District Health Society
The District Health Society will provide training and technical
guidance and perform laboratory quality control. In addition, DHS
should ensure that the smear-positive patients who live outside the
area of services of the microscopy centre are referred appropriately.
The TB programme will monitor diagnostic quality and will list the
facility as a designated RNTCP microscopy centre, as long as services
are free and performance is acceptable. The DHS should ensure that
the microscopy centre provides feedback on results of evaluation of
patients referred by PPs within the stipulated time. DHS should provide
a signboard to be displayed prominently in local language that it is a
government-approved RNTCP laboratory for carrying out sputum
microscopy for TB free of cost. The DHS should ensure that the
system guarantees the initiation of treatment with in a week of the
diagnosis. Review of approval as microscopy centre on an annual
basis must also be carried out.
The DHS will provide Laboratory materials and reagents as well
as laboratory forms and TB Laboratory registers. If needed and
available, the TB Programme should provide a binocular microscope
unless functioning binocular microscope is already available.
DMC Scheme: Designated Microscopy Cum Treatment Centre (A & B)
15
Grant-in-Aid
Rs 25 per slide, but subject to a cap and revocation if fewer than
5% of suspects examined are found to be AFB positive. The laboratory
has to agree to EQA under the RNTCP.
Requirements/Eligibility Criteria
The health facility must have available necessary infrastructure,
a trained microscopist, and a room for the laboratory. The health
facility staff must undergo modular training in microscopy as per
RNTCP guidelines; only specified LTs who have been successfully
trained will conduct sputum examinations; the Laboratory Forms and
Laboratory Register will be maintained as per RNTCP policy and the
facility will be open to on site monitoring by STLS/DTO and other
RNTCP supervisory staff. Binocular microscope should be used for
carrying out sputum microscopy. Reagents of good quality should be
used and properly maintained. The laboratory must maintain adequate
quality of diagnosis - ratio of positive to negative pulmonary cases of
not more than 1:2 to start with and 1:1.2 after one year.
Preference should be given to involving the most heavily utilized
laboratories. The laboratory should, on an average, have a census of
at least 2 chest symptomatics for sputum examination/day after 1 year
of participation in the programme.
DMC Scheme:Designated Microscopy Cum Treatment Centre (A & B)
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LT Scheme: Strengthening RNTCP diagnostic services
17
LT Scheme: Strengthening RNTCP diagnostic
services
Introduction
This activity under the scheme for case detection is applicable
in settings where there is a need for operating a RNTCP-designated
microscopy centre, based on population considerations and workload,
but where the constraint in human resource (Laboratory Technician)
has prevented the establishment of a designated microscopy centre, or
its effective and uninterrupted functioning. The infrastructure of the
proposed designated microscopy centre under this activity should be
under the public sector (e.g. health department of the state/centre,
medical colleges, other public sector health facilities like ESI, public
sector undertakings, etc).
In such an identified laboratory a NGO partner working under
this scheme could provide a solution for the human resource constraint
by providing contractual laboratory technician(s) who will be recruited
and maintained by the partner NGO, but will be assigned to work under
the head of the health facility in which the designated microscopy
centre is located. Such a laboratory technician will be supervised and
guided by the DTO and the local STLS. All designated microscopy
centre under this activity should be under the RNTCP external quality
assessment system. This support by the NGO should be provided to
address short term human resource constraints, usually not exceeding
3 years. Every effort should be made by the local RNTCP programme
manager to address in the longer term this human resource constraint
through the government health system and initiatives/projects that
target health system strengthening.
LT Scheme: Strengthening RNTCP diagnostic services
18
Eligibility
Any registered NGO with capacity and commitment to provide
sustained support for at least 3 years
Grant-in-aid: As per existing RNTCP contractual Lab Technician
salary, + 5% overhead, and recruitment cost reimbursement equal to
one month salary.
The recruitment cost, salary and overheads will be borne either
by the partner NGO, or by RNTCP. In either case the salary of the
laboratory technician should be at par with the prevailing approved
salary of such cadres of staff under RNTCP. In case of RNTCP
funding, the total amount payable by RNTCP to the partner NGO will
be worked out by taking the prorated salary(s) of laboratory
technician(s) for the duration of support and adding to it a recruitment
cost of one month salary (only for new recruits) and an overhead cost
at the rate of 5% of the total salary. E.g. when the RNTCP salary for LT
is Rs.6500 per month the amount payable per laboratory technician
per annum to the NGO will be Rs.88, 400.
Role of NGO/Collaborating partner
􀁠 Recruitment of a suitable laboratory technician via a
competitive mechanism
􀁠 Maintenance of the person on payroll and regular salary
payments
􀁠 Deployment of the person to work at the identified designated
microscopy centre
􀁠 Supervision and monitoring of laboratory technician
performance (with District RNTCP), including conduction of
performance appraisals as and when required in consultation
with the DTO and the head of the health facility housing the
designated microscopy centre.
LT Scheme: Strengthening RNTCP diagnostic services
19
􀁠 In cases where this activity will be funded by the NGO, the
responsibility of resource mobilization will lie with the
NGO.
Role of RNTCP (DTO/STO)
􀁠 Joint planning with the NGO for identification of potential
designated microscopy centres where such support will be
required in order to improve access and quality of sputum
microscopy.
􀁠 Coordination with the NGO and the health society in order to
ensure timely payments to the NGO and the laboratory
technician.
􀁠 Ensure that the lab technician is trained as per RNTCP
guidelines
􀁠 Ensure that the RNTCP external quality assessment protocol
is implemented at the designated microscopy centre.
􀁠 Supervision and monitoring of the performance of the
laboratory technician.
LT Scheme: Strengthening RNTCP diagnostic services
20
Culture and DST Scheme
21
Culture and DST Scheme: Providing Quality
Assured Culture and Drug Susceptibility Testing
Services
Introduction
The programme is in the process of establishing a nation-wide
network of quality assured sputum / specimen culture and drug
susceptibility testing (C&DST) laboratories for the diagnosis and followup
of multi-drug resistant TB (MDR-TB) patients i.e. TB patients who
are resistant to at least rifampicin and isoniazid. This scheme will help
to involve established and well functioning mycobacteriology
laboratories in the non-governmental sector in assisting RNTCP’s
sputum / specimen mycobacterial C&DST activities.
Eligibility
An existing well-functioning mycobacterial culture and DST
laboratory in the private/NGO sector can apply under this scheme. The
applicant laboratory should have adequate infrastructure, equipment
and staff to undertake the sputum culture & DST activities. The
laboratory should be willing to undergo the process of accreditation
under the existing “RNTCP Accreditation Mechanism for Medical
Colleges’ / culture and DST laboratories” (www.tbcindia.org), and also
to undergo routine quality assurance and annual proficiency testing
with an RNTCP National Reference Laboratory (NRL) as per RNTCP
guidelines. Once the laboratory is accredited under RNTCP, a
memorandum of understanding is to be signed between the respective
institution in which the laboratory is located or its governing institution
and the State Health Society of the respective state in which the
institution is situated. The sputum culture and DST services are to be
Culture and DST Scheme
22
provided free of charge to all RNTCP patients who have been referred
by the programme to the respective laboratory for examination.
Grant-in -aid
The initial payment by RNTCP will be based on a pre-decided
number of MDR suspects as per RNTCP DOTS-Plus implementation
plans. The fee payable for sputum / smear, culture, species
identification and drug susceptibility testing for at least the 4 first line
anti-TB drugs, namely Rifampicin, Isoniazid , Ethambutol, and
Streptomycin, will be Rs.2,000/- per specimen, and for undertaking
smear, culture and species identification will be Rs.400/- per specimen.
The programme will provide training to the laboratory staff if required.
The necessary formats, records and reports will also be provided to the
laboratory by the programme. The payments will be made where the
end result of activity is reported with the understanding that a small
proportion of samples may require retesting because of technical
reasons for which there will be no additional payment.
Responsibilities of the NGO/Private Facility:
􀁠 Maintain adequate infrastructure, equipment, consumables
and staff for the laboratory to be fully functional at all times
􀁠 Keep the records and submit reports as per RNTCP guidelines
including indicators for Culture and DST laboratories
􀁠 Effectively co-ordinate with the respective NRL and State TB
Officer (STO) for external quality assessment of the laboratory
at regular intervals.
Culture and DST Scheme
23
Responsibility of the respective STO:
􀁠 Co-ordinate with the respective institution where the laboratory
is located, the respective District TB Officers and NRL in
relation to service provision, training, supervision and quality
assurance.
􀁠 Ensure that timely payment to laboratory is made on a six
monthly basis
􀁠 Ensure that regular reports on the progress of Category IV
/DOTS plus activities undertaken by the concerned laboratory
are sent to CTD and the State level DOTS-Plus Committee.
Culture and DST Scheme
24
Adherence scheme: Promoting treatment adherence
25
Adherence scheme: Promoting treatment
adherence
Introduction:
RNTCP has prioritized decentralization of treatment services as
a means of ensuring that treatment is maximally accessible and
acceptable to patients.
Non-governmental organizations (NGOs) have a long history of
supporting health services at the community level, often with
remarkable effectiveness and rapport with communities. NGOs also
often have capacity to provide excellent treatment support, counselling
for patients, and can contribute to public health oriented activities in TB
treatment, namely address verification and default retrieval.
Individual Private Hospitals, Nursing Homes, Clinics, and
Private providers (PPs) also have many successful examples of
delivering high-quality tuberculosis services to communities in
cooperation with the TB programme, to the benefit of all. PPs are often
more accessible to patients than public health services in terms of
distance and convenience of timings, especially in urban areas.
NGOs and PPs have a major role to play in ensuring that free
high-quality RNTCP drugs are provided to patients that meets National
standards for public health accountability, is maximally effective, and is
highly accessible and acceptable to patients.
Eligibility
NGOs: The NGO must be registered under the Societies Registration
Act, (1860) should have a minimum of one year experience in Outreach
work in health or in related fields and have the necessary
Adherence scheme: Promoting treatment adherence
26
infrastructure. The NGO must provide a plan of action and should
preferably have volunteers who live or work in the area. NGO must
agree to provide services for patients in atleast one tuberculosis unit.
Private Providers: PP should preferably have undergone training in
at least the RNTCP module for Private Practitioners, or at least staff
from the clinic should have undergone RNTCP DOT provider module
training.
Role of the NGO
DOT services:
􀁠 Identify, train, and supervise volunteers who will be providing
DOT.
􀁠 Provide RNTCP treatment to patients at a time and place
accessible and acceptable to patients.
􀁠 Ensure that treatment is provided strictly as per RNTCP policy,
free of charge to patients for any service rendered
􀁠 Ensure that DOT providers maintain records as per RNTCP
policy
􀁠 Ensure the collection of follow up sputum specimens
􀁠 Organize medical care for side effects at appropriate health
services
􀁠 Facilitate payment of RNTCP DOT provision honorarium at
current rate to community DOT providers
􀁠 Assist in providing continuity of care for referred or transferred
patients.
Adherence scheme: Promoting treatment adherence
27
Awareness generation:
􀁠 Conduct IEC activities related to treatment adherence,
including community meetings and patient-provider meetings
􀁠 Creating awareness and linking the patients with the existing
welfare schemes for eligible patients
Counseling services for patients and families
􀁠 Provide package of counseling services to include emotional
support, information on symptoms, disease, duration of
treatment, importance of DOT adherence, side effects,
referrals
􀁠 Services and referrals for substance abuse, harm reduction,
including support for persons who abuse alcohol.
􀁠 Retrieval efforts for interrupters.
Additional services:
􀁠 Transportation of patient wise boxes and treatment cards from
the PHIs to the DOT centers and vice versa.
􀁠 Maintain records of such transfers
These roles apply equally for all categories of RNTCP treatment,
including Category IV treatment for MDR-TB.
Role of the Private Providers
i. Ensure initial home visit for address verification, and
counselling of patient and family members if appropriate.
Adherence scheme: Promoting treatment adherence
28
ii. Provide DOT at least in the premises of the PP clinic/hospital
as per RNTCP guidelines (including ensuring follow-up
sputum examination at DMCs)
iii. Provide INH chemoprophylaxis as per RNTCP policy
iv. Conduct initial retrieval actions for patients who miss doses,
with notification to RNTCP staff if initial retrieval actions fail
to return patient to regular treatment
v. Recording and reporting as per RNTCP guidelines.
Role of the District Health Society
􀁠 Coordinate the identification of partners, NGOs and PPs,
assess eligibility, and assess needs for NGO treatment
coordination and support.
􀁠 Provide training for DOT providers
􀁠 Provide literature for training and orientation is given as
available and appropriate.
􀁠 Provide free anti-TB drugs for patients registered under
RNTCP.
􀁠 Provide sputum containers for follow up examinations.
􀁠 Provide records as required.
􀁠 Support default retrieval for PPs.
􀁠 Provide honorarium for individual DOT providers as per
RNTCP norms.
Adherence scheme: Promoting treatment adherence
29
Grant-in-aid (NGOs)
NGOs supervising DOT services:
Administrative and additional treatment support functions: Rs
40,000 for every 1 lakh population per annum, pro-rata for population
served. (For example, if 5,00,000 population treatment services were
supported with all services, Rs 2,00,000 per annum would be
reimbursed.)
For DOT:
􀁠 Cat 1, 2, and 3 patients: Rs250 to the individual volunteer for
each patient cured or treatment completed
􀁠 Cat 4 patients: Rs 2500/- (Rs 1000/- for IP and Rs 1500/- for
CP) to the individual volunteer for each Cat-4 patient treatment
completed to be disbursed in two installments.
Grant-in-aid (PPs):
PPs providing DOT
􀁠 Rs 400/- per patient successfully treated with all services (i) –
(v) listed above for PPs, i.e. treatment including initial home
visit and default retrieval
􀁠 Rs 250/- per patient successfully treated, where initial home
visit and default retrieval (activities (i) to (iv)) are the
responsibility of:
• An NGO if it is working on the scheme for providing
Directly Observed Therapy in the same area (for which
the NGO will be reimbursed at the rate of Rs 150/- per
patient cured/treatment completed), or
􀁠 By the General Health staff / DTC staff (no Honorarium to be
paid).
Adherence scheme: Promoting treatment adherence
30
􀁠 For Category IV patients, Rs.2,500/- per patient successfully
treated with all the services (i) to (v) listed above [Rs 1000
after completion of IP and Rs 1500 after completion of CP].
Slum Scheme: Improving TB control in Urban Slums
31
Slum Scheme: Improving TB control in Urban
Slums
Introduction
Urban growth has led to rapid increase in the population of
urban slum dwellers. Despite the supposed proximity of the urban poor
to urban health facilities, their access to them may be limited by
inadequacies in the urban public health delivery system, exacerbated
by the lack of standards and norms for the urban health delivery
system compared to rural systems. Slum dwellers are often migrants,
with different language and cultures. Women are often engaged in
work and manual labor, and may have limited time available to address
health care needs. There are high concentrations of particular
occupations such as rickshaw pullers, rag pickers, sex workers, and
other urban poor categories like beggars and destitutes, construction
site workers, alcoholics, drug abusers, street children. These groups
are highly vulnerable to HIV/AIDS. As a result, the urban poor may be
more vulnerable and worse off than their rural counterparts. Poor
environmental conditions in the slums, along with high population
density, make slum-dwellers more vulnerable to tuberculosis and other
diseases of poverty.
Urban slum-dwellers require intensive focus and support from
the tuberculosis programme, as these populations often are not able to
access timely diagnosis or complete the full duration of anti TB
treatment, and hence are at risk of unfavourable treatment outcomes
including deaths, defaults, failures and drug resistance.
Eligibility
Any NGO/Community based organization/Self help
group/Private practitioner with capacity and commitment to provide
sustained support for at least 3 years.
Slum Scheme: Improving TB control in Urban Slums
32
Role of NGO/Collaborating partner
􀁠 Organize IEC activities in slum population for TB and service
awareness
􀁠 Counsel patients for completion of diagnostic process,
treatment initiation, treatment adherence, information
regarding pending migration, and default prevention
􀁠 Collect contact details and other information helpful to locate
patients in the case of migration.
􀁠 Conduct address verification for patients.
􀁠 Address special needs of patients, such as drug abuse,
alcohol abuse
􀁠 Link and facilitate access of patients to appropriate welfare
schemes
􀁠 Facilitate sputum collection and transportation to DMCs
􀁠 Provide DOT as per RNTCP guidelines
􀁠 Retrieve patients who have interrupted treatment, and inform
RNTCP staff regarding patients for whom retrieval efforts are
not successful.
􀁠 Facilitate communication to RNTCP staff regarding impending
migration of patients, so that appropriate referral or transfer
can be arranged.
Slum Scheme: Improving TB control in Urban Slums
33
Role of RNTCP (DTO/STO)
􀁠 Training of NGO and Service providers
􀁠 Provide Sputum cups, IEC material, and printed material
(treatment cards, identity cards etc.).
􀁠 Supervise, monitor and evaluate NGO activities and patient
care.
􀁠 Provide honorarium for individual DOT providers as per
RNTCP norms.
Grant-in-aid: Rs.50,000 per 20,000 population per annum (pro-rata for
slum population size).
The Grant-in-aid for the scheme is Rs.50,000/annum for a
population of 20,000 which includes facility cost, remuneration for the
worker, cost of sputum transportation and administrative cost.
Slum Scheme: Improving TB control in Urban Slums
34
Tuberculosis Unit Model
35
Tuberculosis Unit Model
General Description
The NGO provides all RNTCP services earmarked for a
Tuberculosis Unit (TU; approximately 5 lakh population). Strict
compliance with the Technical and the Operational Guidelines of the
RNTCP is mandatory. In general, this should only be considered in
areas where the governmental infrastructure is not sufficient to ensure
effective RNTCP implementation, and/or where an effective NGO is
currently working in the field of health in this area. One NGO may
cover more than one TU, but must meet all eligibility criteria for each
TU.
Role of the NGO
The NGO ensures full services for microscopy, treatment, direct
observation, defaulter retrieval, recording and registration, supervision,
etc. NGOs should comply with the relevant sections of the Operational
Guidelines of the RNTCP (particularly Chapter 2, Organizational
Structure and Functions) and ensure all programme implementation
responsibilities. The NGO must also coordinate closely with all public
and other health facilities in the area. The NGO must ensure the
fulfillment of all the general functions of the Tuberculosis Unit. It is of
utmost importance that the NGO scrupulously maintains RNTCP
records and submits quarterly reports to the District TB Officer in the
prescribed manner and in a timely fashion.
Tuberculosis Unit Model
36
Role of the District Health Society
The DHS provide technical orientation, guidance, and
supervision. They ensure good integration of the TU operated by the
NGO with other TUs in the District. They include the staff of the TU in
all regular meetings of nodal RNTCP implementing staff. In the case of
TU scheme , prior to rejecting any NGO proposal, the District Health
Society/ State Health Society must seek the approval of the Central TB
Division.
Commodity Assistance
In kind
The RNTCP will provide materials for training and
implementation, including formats and registers; and in-kind provision
of anti-TB drugs, cotrimoxazole (if necessary) and microscopes. Upgradation
of microscopy facilities may be done as commodity
assistance by the DHS, or by grant-in-aid. If required, a 2-wheeler for
mobility of the STS/STLS will be provided. Laboratory consumables
may be provided in kind or as grant-in-aid.
Grant-in-Aid
The available Grant-in-aid is given below. This is to be released
by the DHS to the NGO on a yearly basis (in two installments).
Start-up Activities (one-time only)
Item Amount (in Rs)
Civil works for upgradation of microscopy centres
(up to Rs 30,000 per microscopy centre)
Rs.1,50,000*
Funds for training of multi-purpose workers and
other staff
Rs.40,000 #
Funds for training of multi-purpose supervisors and
related staff
Rs.10,000
Sub-total available for one-time assistance Rs.2,00,000
Tuberculosis Unit Model
37
* This is the maximum amount for a TU, to be based on actual plans
for renovation of the actual number of microscopy laboratories in the
manner laid down in the Guidelines for the District Tuberculosis
Control Society (May, 1998).
# MO training to be paid for by the DHS. If MO training is not paid for
by the DHS, then grant-in-aid would be adjusted by the proportionate
amount as per guidelines for DHS.
Annual Grant-in-Aid Amount (in Rs)
Personnel
(NGO to ensure full-time, mobile staff to serve as
Senior treatment Supervisor & Senior Tuberculosis
Laboratory Supervisor)
Rs.1,80,000
Honoraria for directly observed treatment (@ Rs
250/patient with an assumption that 25% patients will
be with the Community volunteers)
Rs 50,000
General Support (to cover all administrative and
technical costs of running the programme, including
ensuring the presence of an MO of the TB Unit,
book-keeping, getting the accounts audited annually
by a chartered accountant, POL and maintenance of
vehicles, phone calls, faxes, photocopying,
accounting expenses, etc.)
Rs. 3,00,000
Amount available for annual assistance Rs. 5,30,000
Tuberculosis Unit Model
38
Requirements/Eligibility Criteria
The NGO must be registered under the Societies Registration
Act, having a minimum of 3 years experience in health care. It should
have the infrastructure, staff, or volunteers required in the field. The
NGO should give a specific undertaking to the District Health Society
indicating its commitment to provide effective, uninterrupted service in
the area. The NGO must have an established health facility with a
proven track record. All diagnosis, treatment, recording, reporting, and
supervision must be done according to the RNTCP policy. Drugs and
all other services under the RNTCP must be provided free of cost to
patients. The NGO must submit a detailed plan of action, including
available staff, expected TB caseload, diagnostic policies and
treatment procedures. The Memorandum/Letter of Understanding
between the DHS and the NGO must be signed. Upon approval by the
DHS and the State TB Cell, all relevant materials are forwarded to the
Central TB Division, for review and approval. In case the Tuberculosis
Unit does not submit quarterly reports regularly, or if the quarterly
reports show problems in programme implementation which do not
improve after joint supervision, then the arrangement is liable to be
cancelled and an alternative arrangement made by the DHS. Accounts
must be audited every year and audited reports made available to the
District Health Society no later than 15 June each year.
The project area is liable to be visited by the officers of the
Directorate General of Health Services, Ministry of Health and Family
Welfare, Government of India, New Delhi and the State Health Officer.
All the records and registers maintained, the staff, material, and
equipment provided as well as the work done is liable to be inspected.
If the work of the voluntary organizations is not up to the required
standards, and/or if it does not comply with the standards laid down by
the Government of India and if the RNTCP work is stopped, the assets
acquired out of these grants, viz. vehicles, equipments, etc. are
returnable or transferred to a new organization as per advice of the
Government of India/DHS, and the grant-in-aid returned on pro-rata
basis.
TB-HIV Scheme
39
TB-HIV Scheme: Delivering TB-HIV interventions
to high HIV Risk groups (HRGs)
Background
A major component of National AIDS Control Programme’s
(NACO) response to HIV epidemic is ‘Targeted Interventions (TI)’,
which reach out to populations with high risk of contacting HIV infection
to deliver a package of preventive and curative services.
Targeted Intervention Programmes have been undertaken for
various categories of vulnerable population like commercial sex
workers, truck drivers, MSM, eunuchs, etc. The concept of ‘Targeted
interventions’ is based on the pillar of community ownership. These
populations are most at risk of infection of HIV and also most often
marginalized by society, difficult to reach and poor. NGOs undertaking
these targeted interventions utilize peer educators to detect these
populations, build bridges, and provide a package of preventive and
curative services for the targeted communities. As per NACP
guidelines, the NGO team providing these services includes medical
officers, outreach workers, and peer educators.
Even though this target population is expected to have high TB
prevalence (TB being the most common Opportunistic Infection), the
package of services currently does not include TB care. As these
populations have a high HIV prevalence, are marginalized, have
special needs, and do not often access general health services, TB
care and HIV-TB interventions can be offered via these NGOs who are
already working with them successfully for health promotion.
Furthermore, delivery of TB treatment under DOT by general health
services to these populations is a challenge due to issues like high
mobility and stigma.
TB-HIV Scheme
40
However, schemes based on general population norms will not
be available to NGOs serving scattered and heterogeneous target
populations. These NGOs could be covering a number of very
localized geographical areas in case of brothel based commercial sex
workers and community care centres or huge geographic areas
focusing smaller but more challenging populations like street based
sex workers. Hence a dedicated RNTCP scheme is required to ensure
equity of access and to expand TB-HIV interventions into these
challenging populations.
Eligibility
􀁠 NGOs already undertaking NACP Targeted Intervention in the
following identified HIV high populations and catering to a
minimum of 1000 target population of Commercial sex
workers, MSM (Men having Sex with Men), and/or IDUs
(Intravenous Drug Users).
OR
􀁠 NGOs running a NACP accredited/funded Community Care
Centre for HIV, with at least 20 beds.
􀁠 NGO should already be providing HIV care, including clinical
care to the above described High risk populations and
undertaking outreach activities in these populations
􀁠 NGOs being offered the RNTCP scheme should willing to
undertake delivery of comprehensive TB care i.e. all
components as described below
TB-HIV Scheme
41
Role of NGO/Collaborating partner
Under the proposed scheme NGO would undertake delivery of
‘Comprehensive TB Care for HIV high risk populations’ which
includes all of the following components:
1) Intensified TB Case Finding:
a) TB symptom screening through outreach workers and peer
educators at the time of each interaction with the member of
target population & referral of suspects for diagnosis &
treatment
b) TB symptom screening for clients attending these NGO clinics
2) Patient friendly approach for Diagnosis and treatment
categorization:
a) Sputum collection & transportation or Facilitated referrals
b) NGO staff to coordinate with the existing government health
facilities for the diagnosis of smear negative pulmonary TB (for
X-Ray) and Extra-pulmonary TB (for FNAC, etc)
c) TB treatment categorization by NGO clinic medical officer
3) Undertake address verification before initiation of TB treatment
4) Treatment provision:
a) Treatment delivery to be organized by NGO by identification of
appropriate community DOT provider in consultation with the
diagnosed client/ DOT provision through NGO staff if convenient
to the TB patient
5) Adherence:
a) NGO staff to ensure timely follow up of the patient and also
undertake patients retrieval action in case of treatment
interruption;
b) Coordinate with local RNTCP programme staff to ensure
smooth transfer, in case of anticipated migration of patient
c) Monitoring, Supervision & Recording (on treatment cards) by
NGOs
6) Monthly meeting: DTO and NGO
7) Outreach activities by NGOs, out reach workers to include ACSM
TB-HIV Scheme
42
a) Increase visibility of RNTCP for HRG (High Risk Group).
b) Community capacity building/CBO/community involvement in
TB services
c) Advocacy with PLWHA networks for TB control
Role of RNTCP (DTO/STO)
􀁠 Training of NGO and Service providers
􀁠 Provide Sputum cups, IEC material, and printed material
(treatment cards, identity cards etc.).
􀁠 Provide supervision, monitoring and evaluation of NGO
activities and patient care
􀁠 Provide honorarium for individual DOT providers as per
RNTCP norms.
Grant-in-aid: Rs 1,20,000 per NGO per 1,000 Target population (or
one NACP-approved Community Care Centre), increased pro-rata
for larger populations
The Grant-in-aid for the scheme is Consolidated 1.2 Lakhs /
annum for a target population of 1000 or NACP accredited/funded
Community Care Centre for HIV, which is at least 20 bedded for the
described activities. For NGOs catering to larger number of target
population or running larger Community Care Centres, would be
provided financial package on a pro-rata basis.
Procedures
43
PROCEDURES –
One NGO / Private provider could be eligible for
multiple schemes
I. Approvals
1) Advocacy, communication and social mobilization
scheme, Sputum collection center scheme, Sputum pickup
and transportation scheme, Treatment adherence scheme
The DHS establishes collaboration with NGOs for activities of
ACSM scheme without consultation with a higher authority. A copy of
the relevant application, including formats, will be sent to the State TB
Cell and the Central TB Division for information.
2) DMC scheme, LT scheme, Slum Scheme, TB-HIV Scheme
After completion of the application including formats and upon
recommendation by the DHS, approval is obtained from the State TB
Cell. A copy of the relevant application, including formats, will be sent
to the Central TB Division for information.
3) Culture-DST Scheme, Tuberculosis Unit Scheme
After completion of the application including formats and upon
recommendation by the DHS as well as the State TB Cell, approval is
made by the Central TB Division. A copy of the signed Memorandum
of Understanding is to be sent to the State TB Cell and the Central TB
Division.
The updated list of approvals and collaborations must be
maintained at the district and state level for all schemes. The updated
list has to be sent to CTD bi-annually.
Procedures
44
II. Period of Assistance
The normal period will be for one year, to be renewed only on
the basis of satisfactory annual reports of activities, evaluation of
performance by the DHS and recommendation for extension. In case
of poor performance and nondiligence, the contract can be terminated
at any time without prior notice.
III. Human resource
The salary of Laboratory technician in DMC scheme/TU
Scheme/Strengthening of diagnostic services should be at par with the
RNTCP and revised from time to time according to the programme
guidelines. This is also applicable for the STS/STLS salary in the TU
scheme.
45
Revised National Tuberculosis Control Programme
Memorandum of Understanding (MoU) for the
participation of Non-Governmental Organisations
(NGOs)/Private Providers
1. Parties
This is to certify that _____________________________________
[Name of NGO/Private Provider] hence forth referred to as
NGO/PP, has been enrolled as an NGO/Private Provider in the
District of________________________________ [Name of District]
for performance of the following activities in accordance with
RNTCP policy; under the schemes listed below:
(Please tick the appropriate scheme. If a NGO/PP opts for more than one
scheme, tick accordingly on a single MOU. Strike out whichever is not
applicable).
i. TB advocacy, communication, and social mobilization
scheme
ii. Sputum collection centre/s Scheme
iii. Sputum pickup and transportation Scheme
iv. Designated Microscopy Centre Scheme
v. Laboratory Technician Scheme
vi. Culture-DST Scheme
vii. Treatment Adherence Scheme
viii. Urban Slum Scheme
ix. Scheme for Tuberculosis Unit
x. TB-HIV Scheme
2. Period of Co-operation:
The NGO/Private Provider agrees to perform all activities outlined
in the RNTCP NGO/Private Provider schemes. The duration of cooperation
will be from ___/___/_____ (dd/mm/yyyy) to
___/____/____ (dd/mm/yyyy). In case of poor performance and
non-diligence, the contract can be terminated by the DHS at any
time without prior notice.
46
3. Terms, conditions and specific services during the period of
the MOU.
A. The District/State Health Society shall (please strike out which
ever is not applicable)
i. Provide financial and material support to the NGO/Private
Provider for carrying out the activities as mentioned in the
NGO/Private Provider scheme
ii. Provide relevant technical guidelines and updates (manuals,
circulars, etc.)
iii. Provide RNTCP medicines and laboratory consumables for
use as per RNTCP policy as outlined the scheme
iv. Periodically review the activities being undertaken by the
NGO/Private Provider
B. The NGO/Private Provider will: -
i. Perform all activities as mentioned under the scheme for
which MoU is signed.
ii. Submit utilization certificate indicating expenditure during the
quarter and available unspent balance to the respective
State/District Health Society on quarterly basis.
iii. Maintain adequate documentation of as per RNTCP policy
which is mentioned under the scheme.
iv. Get commodity assistance as per the scheme.
C. Grant-in-Aid
Funds will be released bi-annually by the respective health
society in the name of the NGO/Private Provider.
The NGO/Private Provider will submit utilization certificate indicating
expenditure during the particular quarter and available unspent
balance to the respective State/District Health Society on quarterly
basis. The subsequent release will depend on the unspent balance
and committed liability (if any).
47
In case services of NGO are discontinued, unspent balance, if any will
be refunded.
Necessary approval from the Central TB Division/ State Health Society
has been obtained: Yes/ No/ Not applicable.
Enclosures: Copy of the NGO/Private Provider schemes.
________________________ _________________________
Signature of STO/DTO Signature of authorised signatory
(on behalf of the (on behalf of the NGO
respective SHS/DHS) / Private Provider)
Seal Seal